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By the way, doctor: Are sleeping pills addictive?

Q. My primary care doctor tells me that all sleeping pills
on the market are addictive. Does this mean you develop a craving
for them or simply that you become unable to sleep without taking
them? I'm 92 and realize that easy sleep and age aren't
compatible. Please advise.

A. I'd call sleeping pills variably addictive. People
don't crave them the way that, say, a heroin addict craves
heroin. But many people do become psychologically dependent —
they believe they can't sleep without them. And it's not just in
their heads, either. If people take sleeping pills for a while
and then stop, they often experience a rebound effect, becoming
more wakeful and restless and agitated at bedtime than ever
before.

But as a geriatrician, I don't worry as much about dependence and
rebound as I do side effects. Sleeping pills — especially the
longer-acting benzodiazepines like diazepam (Valium) and
flurazepam (Dalmane) — linger in the body, so people feel drowsy
and "out of it" during the day. Drowsiness, particularly among
older people, causes falls and accidents. Shorter-acting sleeping
pills were developed to avoid this problem, but in my experience,
some people develop a tolerance for them, so they wind up taking
more pills to get the same sleep-inducing effect and daytime
sleepiness still is a problem.